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July 11, 2007

Algorithms for Assessing Cardiovascular Risk in Women

JAMA. 2007;298(2):175-178. doi:10.1001/jama.298.2.175

To the Editor: In their study of algorithms for assessing cardiovascular risk in women, Dr Ridker and colleagues1 conclude that the Reynolds risk score reclassified 40% to 50% of women at intermediate risk into higher- or lower-risk categories. This conclusion is misleading and based on incomplete analytical methodology. The proportion of women reclassified is based on Table 5 in the article, which compares the Reynolds risk score with the Third Report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (ATP III) model.2 However, the latter model was developed for hard coronary heart disease end points (myocardial infarction or coronary death). The broader definition of cardiovascular disease used in the Reynolds risk score translates into larger 10-year absolute risks, which may be reflected as enhanced reclassification. We therefore believe that Table 5 has limited merit.

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